Taiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking.
This study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan.
A multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors.
With a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU.
Synchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control.
Frontiers in oncology. 2022 Jan 13*** epublish ***
I-Hsuan Alan Chen, Chao-Hsiang Chang, Chi-Ping Huang, Wen-Jeng Wu, Ching-Chia Li, Chung-Hsin Chen, Chao-Yuan Huang, Chi-Wen Lo, Chih-Chin Yu, Chung-You Tsai, Wei-Che Wu, Jen-Shu Tseng, Wun-Rong Lin, Yuan-Hong Jiang, Yu-Khun Lee, Yeong-Chin Jou, Ian-Seng Cheong, Thomas Y Hsueh, Allen W Chiu, Yung-Tai Chen, Jih-Sheng Chen, Bing-Juin Chiang, Yao-Chou Tsai, Wei Yu Lin, Chia-Chang Wu, Jen-Tai Lin, Chia-Cheng Yu
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan., Department of Urology, China Medical University and Hospital, Taichung, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan., Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan., Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan., Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan., Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan., College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.